The Grange Care Home

Updated 10 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We used information the registered persons sent us in the Provider Information Return. This is information we require registered persons to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also examined other information we held about the service. This included notifications of incidents that the registered persons had sent us since our last inspection. These are events that happened in the service that the registered persons are required to tell us about. We also invited feedback from the commissioning bodies who contributed to purchasing some of the care provided in the service. We did this so that they could tell us their views about how well the service was meeting people’s needs and wishes.

We visited the service on 6 November 2018 and the inspection was unannounced. The inspection team consisted of three inspectors.

We met and spoke with eight people who lived at the service, we observed some people’s care in communal areas, the lunchtime meal, medicine administration and activities. We spoke with two people’s relatives. We inspected the environment, including the laundry, bathrooms and some of the bedrooms. We spoke with two care staff, housekeeping and kitchen staff as well as the temporary manager, and new manager.

In addition, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us.

During the inspection we reviewed other records. These included staff training and supervision records, four staff recruitment records, nursing staff registrations, medicine records, risk assessments, accidents and incident records, quality audits and policies and procedures.

We displayed a poster in the communal area of the service inviting feedback from people, relatives and staff. Following this inspection visit, we did not receive any additional feedback.

Updated 10 January 2019

This inspection was completed on 6 November 2018 and was unannounced.

The Grange is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is a large detached property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. The Grange Care Home provides care for up to 28 older people living with dementia, frailty and mobility care needs. There were 11 people living at the service at the time of our inspection.

There was no registered manager at the time of our inspection. However, the manager of a sister service, owned by the same provider, had applied to become the registered manager of The Grange. Their application had been received by CQC and was being processed. Their registration to manage The Grange was intended to be temporary, this was because a new manager for The Grange had been appointed and was receiving mentoring for the role. Once established, the new manager would apply for the registered manager post at The Grange and the manager of the sister service would return to their original service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The temporary manager is referred to as the temporary manager and the new manager is referred to as the acting manager in this report. Jointly, they are referred to as the managers.

Our last inspection of this service took place in July 2018. This was a focussed inspection which looked at the key areas of Safe, Effective and Well Led. Each of these areas were rated as Requires Improvement, together with the overall rating of the service. This was because requirements about the administration and storage of some medicines were not always complied with. Recruitment processes were not as thorough as needed because some gaps in employment history were unexplained and some references from previous employers were missing. The service was not suitably well led because a number of checks and audits failed to address shortfalls in the safety and quality of the service provided. We also found the provider had failed to comply with a condition of their registration because they had not made suitable arrangements to have a registered manager in post.

This inspection was completed on 6 November 2018. It was a full inspection which looked at all five key areas of the service. At this inspection we found improvements had been made and the breaches of regulation identified at the last inspection had been met.

The management of people’s medicines was safe. Risks had been identified and action had been taken to manage them. Records about people and the care they received were accurate, complete, held securely and easily accessible to staff when they needed them.

There were enough staff to provide the care and support people needed when they wanted it. New staff were recruited safely. Disclosure and Barring Service (DBS) criminal records checks had been completed to make sure staff were suitable for their role. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role.

Staff were kind and caring and treated people with dignity and respect. They took time to get to know each person well and provide the care people wanted in the way they preferred. People received the care and support they wanted at the end of their life.

Assessments of people’s needs and any risks were completed and care had been planned with them, to meet their needs and preferences and keep them safe. Accidents and incidents were analysed to look for patterns and trends. The temporary manager worked in partnership with the local authority safeguarding and commissioning teams as well as a clinical nurse specialist for older people. The service had acted on their advice to develop the service and improve people’s care.

Staff knew the signs of abuse and were confident to raise any concerns they had with the managers or provider. People were not discriminated against and received care tailored to them. A process was in operation to investigate and resolve complaints to people’s satisfaction. People had enough to do during the day, including activities to keep them physically and mentally active.

Changes in people’s health were identified and people were supported to see health care professionals, including GPs when they needed. People were offered a balanced diet of food they liked, which met any specific dietary or cultural needs and preferences. Staff supported people to be as independent as they wanted at mealtimes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The managers knew when assessments of people’s capacity to make decisions were needed. Information was available to people in a way they understood to help them make decisions and choices. Staff treated people with dignity and gave them privacy. The managers understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

Staff felt supported by the managers and were motivated. A member of the management team was always available to provide the support and guidance staff needed. Staff worked together to support people to be as independent as they wanted to be. All the staff we spoke with told us they would be happy for their relatives to live at The Grange and that they were proud to work there. The views of people, their relatives, staff and community professionals were asked for and acted on to continually improve the service.

The service was clean, staff followed infection control processes to protect people from the risk of infection. The building was well maintained, plans were in operation to maintain and improve the environment. People were able to use all areas of the building and grounds.

The managers had informed CQC of significant events that had happened at the service, so we could check that appropriate action had been taken.

Services are required to prominently display their CQC performance rating. The provider had displayed the rating in the entrance hall and on their website.

Further information is in the detailed findings below.